Ongoing Evaluations Research Articles

To Perform or Not to Perform: Exploring the Impact of COVID‐19 on Aotearoa New Zealand's Performing Arts Sector

ABSTRACTThis article explores narratives of how COVID‐19 impacted the performing arts sector, by drawing on interviews with creative workers in Aotearoa New Zealand. Despite the late exposure to COVID‐19 and the adoption of an elimination approach that afforded opportunities for performing arts to continue to varying extents between 2019 and 2022, cultural workers in Aotearoa New Zealand, as with their overseas counterparts, experienced significant and consequential disruption to their working conditions and lives. Taking into account the specificity of Aotearoa New Zealand's performing arts sector and the government's COVID‐19 response, the article contributes to the empirical examination of COVID‐19 experiences by teasing out narratives of impact from cultural workers. The thematic analysis demonstrates how participants presented (1) COVID‐19 as responsible for financial, emotional, and psychological costs, (2) framed opportunities arising from disrupted working conditions and wage subsidy as “silver linings,” (3) were reliant on digital technologies, and (4) constructed the return to “normal” as marked by the COVID‐19 “aftermath.” The article argues that uniting these perceptions and articulations of impact is the ongoing (re)evaluations of risks and benefits by cultural workers of working conditions that predate COVID‐19.

From outdated to outstanding: an institution’s journey in reforming the dental materials science curriculum and lessons learned

BackgroundThe Dental Materials Science (DMS) course within Malaysian undergraduate dental education has traditionally been taught in isolation, with a relatively stagnant delivery mode. Recent shifts in national dental competency standards have necessitated substantial reform in the DMS curriculum. This study aims to outline the journey of a local dental institute in developing and implementing a competency-based DMS curriculum.MethodsA faculty curriculum task force was established to oversee the curriculum reform process. The reform was guided by a “bottom-up” approach using the five-step curriculum reform model: (1). Curriculum mapping, (2). Comprehensive needs assessment, (3). Clear learning objectives and outcomes, (4). Curriculum development and implementation, and (5). Continuous evaluation and improvement.ResultsStep 1 revealed the need to reduce content repetition and improve alignment with the new competency standards. Step 2 identified the need to include advanced materials, integrate theoretical and clinical aspects, and enhance teaching methods. The new curriculum included 25 relevant topics. Step 3 established three course learning outcomes, while Step 4 integrated DMS content horizontally and vertically across the curriculum, introduced innovative teaching methods, and diversified assessment methods. Step 5 ensured ongoing curriculum monitoring, with both short-term and long-term evaluations planned.ConclusionThe curriculum reform process represents a significant advancement in dental materials science while addressing challenges and aligning the curriculum with national standards. Ongoing evaluation, adaptability, interdisciplinary collaboration, and international engagement are essential for further improvements. This journey serves as a valuable reference for educators seeking to update their DMS curricula.

Practice of Python in Programming and Optimization of Quantitative Analysis Model of Fixed Income

Python has become an indispensable tool in fixed income trading. This paper introduces the principles and general process of data analysis visualisation by analysing the basic operation and performance of personal investment and finance, combined with data analysis in the era of big data. The library of data analysis tools using Python has become an indispensable tool in fixed income trading. In fixed income trading, it supports fixed income traders to handle tasks such as bond pricing, interest rate modelling, and credit risk analysis Using Python's powerful data processing capabilities, traders can simplify data collection, analysis, and reporting to make better decisions. Based on the Python language, financial data is acquired from different platforms, processed and analysed step-by-step, ensuring that the model remains accurate and stable in different market conditions. Backtesting and ongoing performance evaluations have revealed that Python can be a valuable asset in the dynamic world of fixed income trading by refining trading strategies and effectively managing risk.

Platelet-rich plasma for treatment of female stress urinary incontinence.

Stress urinary incontinence (SUI) poses a significant burden on affected individuals, impairing their quality of life and causing embarrassment due to involuntary urine leakage during activities such as sneezing or coughing. While conservative and surgical treatments exist, a subset of patients experiences persistent symptoms despite these interventions. This review provides insights into the potential role of platelet-rich plasma (PRP) as a therapeutic adjunct for patients with SUI that does not respond to conventional non-surgical or surgical treatments. We conducted a literature review of studies in English to evaluate PRP efficacy in managing SUI. The studies conducted on PRP therapy suggest that it is an effective and safe treatment option for SUI in women. PRP injections, when used alone or in combination with other therapies, have shown significant improvements in SUI symptoms. Moreover, these studies indicate that PRP injections offer a less invasive and low-risk alternative to surgical procedures for managing SUI, which could lead to shorter recovery times. The efficacy of PRP therapy is evidenced by significant reductions in SUI symptoms, as well as improvements in bladder function variables, without significant adverse effects reported. However, further research is necessary to establish the long-term effectiveness and safety of PRP therapy for managing SUI in diverse patient populations. Additionally, ongoing evaluations of PRP therapy in combination with other interventions will be essential for optimizing treatment outcomes and broadening the potential applications of PRP in the management of SUI.

Assessment of Waste Management Program Implementation in a Local Community

The general background this research focuses on the implementation of the Integrated Waste Management Program (TPST) to address waste management issues at the village level. Specific background includes the lack of understanding regarding the effectiveness of existing waste management programs, which often do not run optimally. Knowledge gap this drives further research to evaluate these programs. Aims of this research is to describe and analyze the implementation of the TPST waste management program and assess the indicators that influence its success. Results of the research show that the implementation of this program is considered quite good with the indicators of communication, resources, disposition, and bureaucratic structure having been met. Novelty of this research lies in the application of implementation theory by George Edward III in the context of waste management in villages, providing new insights into the factors that influence program effectiveness. Implications of this research suggest that village governments conduct ongoing evaluations and improvements to facilities and infrastructure to enhance the quality of waste management and produce organic fertilizer, thereby reducing the amount of residue generated. Highlights: Implementation assessed through indicators: communication, resources, disposition, and bureaucratic structure. Ongoing evaluations are essential for enhancing waste management effectiveness. Recommendations include improving facilities to produce organic fertilizer and reduce waste residue. Keywords: Waste Management, Integrated Program, Implementation, Community Engagement, Resource Allocation

The Cancer Patient Empowerment Program: A Comprehensive Approach to Reducing Psychological Distress in Cancer Survivors, with Insights from a Mixed-Model Analysis, Including Implications for Breast Cancer Patients.

Psychological distress is a significant concern among cancer patients, negatively affecting their quality of life and adherence to treatment. The Cancer Patient Empowerment Program (CancerPEP) was developed as a comprehensive, home-based intervention aimed at reducing psychological distress by incorporating physical activity, dietary guidance, and social support. This study aimed to evaluate the feasibility, accrual and attrition rates, safety, and effectiveness of the CancerPEP intervention, with and without the biofeedback device, on psychological distress from baseline to 6 months, specifically focusing on the effects of group randomization and the difference between pre- and post-intervention results. This single-site, crossover randomized clinical trial included 104 cancer patients who were randomized to receive the CancerPEP intervention, with or without a Heart Rate Variability (HRV) biofeedback monitor. At 6 months, participants who did not receive the device were allowed to use one until the end of the year, while those who did receive the device were followed up to 12 months. Randomization was stratified by the presence or absence of clinically significant psychological distress and metastatic status. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) at baseline, 6 months, and 12 months. The primary endpoint was the presence of nonspecific psychological distress, as measured by the K10 scale at 6 months from the trial start, based on group randomization. A secondary exploratory analysis assessed psychological distress at baseline, 6 months, and 12 months for both groups, while controlling for group randomization and prognostic covariates. Prognostic covariates included age; comorbidities; time between diagnosis and randomization; treatment modality; relationship status; and use of prescribed medications for anxiety, depression, or both. An exploratory sub-analysis was conducted for the breast cancer subgroup, based on the sample size available after recruitment. The trial is registered at ClinicalTrials.gov (NCT05508412). The provision of the HRV biofeedback monitor in conjunction with the CancerPEP intervention did not significantly affect the primary outcome in either the full sample or the breast cancer subgroup, indicating that the HRV biofeedback provision was not beneficial in this trial. No self-reported or otherwise discovered adverse events at the 6-month mark were observed. About 10% of participants were lost to follow-up in both the early and late HRV monitor provision groups. Participation in the CancerPEP program led to a significant reduction in psychological distress over time. The odds of psychological distress were significantly higher at the start of the trial than at the end of the intervention (aOR = 2.64, 95% CI: 1.53-4.56) or 6 months after the intervention (aOR = 2.94, 95% CI: 1.62-5.30). Similarly, in the breast cancer subgroup, distress was higher at the trial's start than at 6 months, i.e., after the intervention (aOR = 2.25, 95% CI: 1.24-4.08), or at the end of the trial at 12 months (aOR = 2.73, 95% CI: 1.35-5.52). CancerPEP significantly reduces psychological distress in cancer patients, with consistent improvements noted across various cancer types and stages, including benefits specifically for breast cancer patients. These findings build upon the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), indicating that a similar comprehensive intervention can be advantageous for all cancer patients and may be further tailored to address specific needs. With its holistic approach-encompassing physical, dietary, and psychosocial support-CancerPEP shows promise as a vital component of survivorship care. Ongoing 24-month evaluations will yield critical data on its long-term benefits. Additionally, a randomized trial with a control group (usual care without intervention) for breast cancer patients is currently under way and could potentially guide the integration of CancerPEP into standard oncology care to enhance patient outcomes and quality of life.

Enhancing Team Dynamics and Leadership Skills for Residents Leading Multidisciplinary In-Patient Cardiac Arrest Teams

Background: Cardiac arrest is a prevalent event with low survival rates, both in out-of-hospital and in-hospital settings. There is a lack of specific training programs addressing team dynamics and leadership skills during resuscitation events, creating a clinical gap. This project aimed to enhance team dynamics and improve leadership skills during IHCA resuscitation events. Methods: We implemented the Mock Code Project for resident physicians from our Internal Medicine Residency Programs in the simulation center (i.e., in a controlled environment) to address this gap. Multidisciplinary team mock code scenarios were created for residents, allowing them to lead resuscitation simulations. The scenarios were based upon common conditions encountered during codes (Cardiac arrest). Trained evaluators provided real-time feedback, and pre-and post-surveys were conducted to assess team perception and gather feedback. Results: Baseline data revealed that 98.6% (143 of 145 residents total) felt uncertain or lacked confidence in leading effective codes in our hospital prior to the intervention. Post-test survey outcome data revealed that 95.1% of participants (136 residents of 143) reported that the sessions challenged their skills at leading codes and improved their skills at managing resuscitation teams. Conclusion: Organized codes with clear roles, responsibilities, bed positioning, and clear leadership significantly improve closed-loop communication, effective team interaction, and patient outcomes. The Mock Code Project fills the gap in training programs by focusing on team dynamics and leadership skills during IHCA resuscitation. Ongoing evaluations and feedback ensure continual improvement in resident confidence and skills. Implementing organized codes benefits residents and healthcare teams, ultimately improving patient care during IHCA. Well-designed mock code scenarios with real-time feedback from senior physicians are an effective way for trainees to develop these skills and this awareness without compromising patient safety.

Soil gas gradient method for estimating natural source zone depletion rates of LNAPL and specific chemicals of concern

This paper presents a simplified approach for the soil gas gradient method for estimating natural source zone depletion (NSZD) rates of specific contaminants of concern (COCs) at sites contaminated by light non-aqueous phase liquids (LNAPL). Traditional approaches to quantify COC-specific NSZD rates often rely on numerical or analytical reaction-transport models that require detailed site-specific data. In contrast, the proposed method employs simple analytical solutions, making it more accessible to practitioners. Specifically, it requires only the maximum soil gas concentration, the effective diffusion coefficient, and the diffusive reaction length calculated from vertical soil gas concentration profiles. The simplified approach was validated against a reactive transport numerical model reported in the literature, showing consistent results within the same order of magnitude for BTEX NSZD rates at a gasoline spill site in South Carolina. Further validation using a larger dataset involved comparing NSZD rate estimates for benzene and total petroleum hydrocarbons (TPH) against those obtained using BioVapor, utilizing empirical soil gas data from the USEPA Petroleum Vapor Intrusion Database. Results demonstrated a strong correlation between NSZD rates and maximum soil gas concentrations, allowing the development of a rapid screening approach based only on the measured soil gas concentrations and literature values for diffusion coefficients and diffusive reaction lengths. This approach aligned well with previous modeling studies and was consistent with literature values for TPH NSZD rates. Overall, both the simplified and screening approaches offer practical, easy-to-use tools for evaluating temporal variability in natural attenuation rates, supporting baseline assessments and ongoing performance evaluations of remediation at LNAPL sites.

Establishing a novel score system and using it to assess and compare the quality of ChatGPT-4 consultation with physician consultation for obstetrics and gynecology: A pilot study.

In the current study, we aimed to establish a quantified scoring system for evaluating consultation quality. Subsequently, using the score system to assess the quality of ChatGPT-4 consultations, we compared them with physician consultations when presented with the same clinical cases from obstetrics and gynecology. This study was conducted in the Women and Children's Hospital of Chongqing Medical University, a tertiary-care hospital with approximately 16 000-20 000 deliveries and 8500-12 000 gynecologic surgeries per year. The detailed data from obstetric and gynecologic medical records were analyzed by ChatGPT-4 and physicians; the consultation opinions were then generated respectively. All consultation opinions were graded by eight junior doctors using the novel score system; subsequently, the correlation, agreement, and comparison between the two types of consultation opinions were then evaluated. A total of 100 medical records from obstetrics and 100 medical records from gynecology were randomly selected. Pearson correlation analysis suggested a noncorrelation or weak correlation between consultations from ChatGPT-4 and physicians. Bland-Altman plot showed an unacceptable agreement between the two types of consultation opinions. Paired t tests showed that the scores of physician consultations were significantly higher than those generated by ChatGPT-4 in both obstetric and gynecologic patients. At present, ChatGPT-4 may not be a substitute for physicians in consultations for obstetric and gynecologic patients. Therefore, it is crucial to pay careful attention and conduct ongoing evaluations to ensure the quality of consultation opinions generated by ChatGPT-4.

Character Formation and Moral Development in Children Through Mosque Engagement Programs

The formation of akhlakul karimah (noble character) is an important aspect of children's education in Islamic teachings, which includes good moral and ethical values. This study is based on the aim to explore the effectiveness of mosque-centered activities in fostering these values among children. The background of this study highlights the important role of mosques in guiding children towards good morals through various religious activities. The methodology of this paper is based on Participatory Action Research (PAR) which involves active collaboration with community members in the planning, implementation, and evaluation of the program. This approach includes counseling and training on akhlakul karimah values, organizing religious activities such as calligraphy, hadrah, qiro'ah, and Qur'an reading, increasing parental and community involvement, and conducting ongoing evaluations to assess the impact of the program. The findings of the study revealed that the mosque-centered approach plays an effective role in fostering positive attitudes and behaviors among children. Mosque-centered activities can also provide a positive impression to the community about the importance of prospering the mosque. The results of this study are expected to provide an understanding of how religious institutions such as mosques can play an important role in the moral and ethical development of children through community involvement and active participation.

Entrepreneurship Training and Mentoring for Sportswear Production at the Branch Leadership of LPM SMA Muhammadiyah Program Khusus Sambi Boyolali

The entrepreneurship training and mentoring initiative at PR IPM SMA Muhammadiyah PK Sambi Boyolali focuses on equipping members with essential skills in sportswear production and micro-business management. This program encompasses training in production techniques, business operations, and marketing strategies. The process is carefully structured, beginning with a thorough needs assessment, followed by a well-planned two-month program, and culminating in the development of educational materials aligned with a specialized Sports Entrepreneurship curriculum. Participants successfully produced themed sports jerseys and casual t-shirts, and also established a promising business unit within PR IPM SMA Muh. PK Sambi Boyolali. With its emphasis on sustainability, this initiative is poised to serve as a robust model for entrepreneurship development among students and other Muhammadiyah youth groups. Ongoing evaluations and adaptive program strategies are integral to ensuring the continued success and longevity of this endeavor.

Fat Grafting and Prepectoral Prosthetic Reconstruction with Polyurethane-Covered Implants: Protective Role against Adjuvant Radiotherapy.

Background/Objectives: Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture and implant migration, compared to the traditional submuscular technique, these patients have higher rates of long-term complications when compared with nonradiated patients. This study evaluates the protective effects of autologous fat grafting to reduce long-term radiotherapy-induced complications in breast cancer patients submitted for prepectoral reconstruction with polyurethane-covered (PU) implants. Methods: A pilot study with two parallel cohorts of patients undergoing an NSM or SSM followed by PMRT was conducted. Patients were randomly assigned to either of the two groups to ensure homogeneity. One cohort underwent autologous fat grafting sessions, individually tailored based on periodic evaluations by the principal investigator (PI), M. Salgarello, at least six months after PMRT. The control group received standard clinical follow-ups without fat grafting. Inclusion criteria ensured participants were disease-free, non-smokers, and had a LENT-SOMA score within 2. Results: Preliminary findings indicate significant differences between the groups, with improved outcomes observed in patients undergoing tailored lipofilling. Specifically, these patients experienced a notable reduction in capsular contracture severity and reported higher satisfaction with the aesthetic results compared to the control group. Conclusions: Autologous fat grafting, customized per patient by the PI based on ongoing evaluations, appears to mitigate some adverse effects of radiotherapy in prepectoral breast reconstruction, suggesting a viable option for enhancing surgical outcomes in irradiated patients. Further research is needed to substantiate these findings and evaluate long-term benefits.

Preventing Cyberbullying in Nigeria: The Effectiveness of Social Media Literacy Education for Young People

The widespread integration of technology into daily life has transformed human interactions, creating unprecedented opportunities for creativity, collaboration, and communication. However, this digital evolution has also exacerbated cyberbullying, which poses significant threats to global and individual well-being. Cyberbullying is particularly prevalent among teenagers, who are active users of digital platforms and highly vulnerable to its negative impacts. In Nigeria, rapid technological advancements have heightened the incidence of cyberbullying, severely affecting the mental health, social development, and overall well-being of young people. This study aims to assess the effectiveness of social media literacy programs in reducing cyberbullying among Nigerian youth and examine how sociocultural and technological factors influence these interventions. Employing a quantitative cross-sectional design, data were collected from 480 students across three tertiary institutions in Lagos State using validated questionnaires. The findings revealed that social media literacy programs significantly reduced cyberbullying incidents. This study underscores the need for culturally sensitive and contextually appropriate interventions and highlights the importance of comprehensive strategies that address Nigeria's unique sociocultural and technological landscapes. Recommendations include the development of robust, evidence-based social media literacy programs tailored to diverse Nigerian communities, enhanced collaboration among stakeholders, and ongoing evaluations to refine and sustain these initiatives.

Inspection prioritization of gravity sanitary sewer systems using supervised machine learning algorithms

Underground wastewater collection systems degrade with time, necessitating utility owners to engage in ongoing evaluations and enhancements of their asset management frameworks to preserve the performance of their assets. The inspection and condition assessment of sewer pipes are crucial for the effective operation and maintenance of sewer systems. The closed-circuit television (CCTV) is frequently employed to examine sewer pipes in the United States. This procedure is both costly and laborious because of the extensive number of pipes in a metropolis. Prioritisation of inspection for sanitary sewage pipe segments requiring repair or maintenance can be done in advance depending on their past performance. Hence, the aim of this study is to construct a predictive model for the state of sanitary sewer pipes, utilising data collected from a city located in the southcentral region of the United States. The main contribution is that this study used multiclass classification and predicted PACP scores of the pipes. Condition prediction models were developed using extensively utilised supervised machine learning algorithms including logistic regression (LR), k-nearest neighbors (k-NN), and random forest (RF). However, the bulk of the constructed models were assessed using a limited number of assessment measures, such as the receiver operator characteristic (ROC) curve and the area under the curve (AUC) value. This paper asserts that the assessment of the predictive capacity of these models cannot be determined only by relying on ROC and AUC values. Out of the three models evaluated in this study, the LR model had an AUC value of 0.76. However, this model had a higher number of misclassifications or inaccurate predictions compared to the other models. Consequently, these models were assessed using additional assessment measures, including precision, recall, and F-1 scores (which represent the harmonic mean of precision and recall). Curiously, the LR model achieved an F1-score of 0.28 on a scale ranging from 0 to 1. The RF model yielded an F1-score of 0.45 and an AUC value of 0.86. The existing model can be enhanced before it is employed by asset managers during the inspection phase to assess the state of their sanitary sewers and identify essential sewers that require immediate care.

Predictive Validity of Anesthesiologists' Quality of Clinical Supervision and Nurse Anesthetists' Work Habits Assessed by Their Associations With Operating Room Times.

At all Joint Commission-accredited hospitals, the anesthesia department chair must report quantitative assessments of anesthesiologists' and nurse anesthetists' (CRNAs') clinical performance at least annually. Most metrics lack evidence of usefulness, cost-effectiveness, reliability, or validity. Earlier studies showed that anesthesiologists' clinical supervision quality and CRNAs' work habits have content, convergent, discriminant, and construct validity. We evaluated predictive validity by testing for (expected) small but statistically significant associations between higher quality of supervision (work habits) and reduced probabilities of cases taking longer than estimated. Supervision quality of each anesthesiologist was evaluated daily by assigned trainees using the 9-item de Oliveira Filho scale. The work habits of each CRNA were evaluated daily by assigned anesthesiologists using a 6-item scale. Both are scored binary, 1 if all items are rated the maximum, 0 otherwise. From 40,718 supervision evaluations and 53,722 work habit evaluations over 8 fiscal years, 16 mixed-effects logistic regression models were estimated, with raters as fixed effects and ratees (anesthesiologists or CRNAs) as random effects. Empirical Bayes means in the logit scale were obtained for 561 anesthesiologist-years and 605 CRNA-years. The binary-dependent variable was whether the case took longer than estimated from the historical mean time for combinations of scheduled procedures and surgeons. From 264,060 cases, 8 mixed-effects logistic regression models were fitted, 1 per fiscal year, using ratees as random effects. Predictive validity was tested by pairing the 8 one-year analyses of clinical supervision, and the 8 one-year analyses of work habits, by ratee, with the 8 one-year analyses of whether OR time was longer than estimated. Bivariate errors in variable linear least squares linear regressions minimized total variances. Among anesthesiologists, 8.2% (46/561) had below-average supervision quality, and 17.7% (99/561), above-average. Among CRNAs, 6.3% (38/605) had below-average work habits, and 10.9% (66/605) above-average. Increases in the logits of the quality of clinical supervision were associated with decreases in the logits of the probabilities of cases taking longer than estimated, unitless slope = -0.0361 (SE, 0.0053), P < .00001. Increases in the logits of CRNAs' work habits were associated with decreases in the logits of probabilities of cases taking longer than estimated, slope = -0.0238 (SE, 0.0054), P < .00001. Predictive validity was confirmed, providing further evidence for using supervision and work habits scales for ongoing professional practice evaluations. Specifically, OR times were briefer when anesthesiologists supervised residents more closely, and when CRNAs had better work habits.

Adaptability and integration influence on adaptive capacity of small- and medium-scale construction organisations

PurposeAdaptability and integration (ADI) are the core ingredients for environmentally sustainable construction (ESC), which preserves the ecology from unsupported human activities. However, the approach is lagging in developing countries, which has led to studying the influence of ADI on the adaptive capacity of small- and medium-scale construction organisations.Design/methodology/approachThe research employed a quantitative methodology, collecting 400 responses as a sample size. A construct of 14 influential factors concerning ADI within the Ghanaian small and medium-scale construction industry was developed. The data obtained from participants underwent analysis using SPSS version 26. The validity of the study’s findings was assessed by applying structural equation modelling (SEM) within the AMOS software.FindingsIt was evident that innovation advancement and ongoing training and evaluations significantly influence ADI for adaptive capacity. Moreover, the system internally and vulnerability (SIV) and perceived need for implementation (PNI) sub-scales were the main latent components for best construction practices.Practical implicationsGhana’s small- and medium-scale construction organisations have yet to fully recognise the importance of ADI in enhancing adaptive capacity for the best ESC. However, the results indicated that ADI constructs will significantly influence implementation outcomes to ensure ESC.Originality/valueThe originality of this research also resides in identifying how ADI affect small- and medium-scale construction organisation’s ability to ensure ecologically sustainable building practices.

Novel intravital approaches to quantify deep vascular structure and perfusion in the aging mouse brain using ultrasound localization microscopy (ULM).

Intra-vital visualization of deep cerebrovascular structures and blood flow in the aging brain has been a difficult challenge in the field of neurovascular research, especially when considering the key role played by the cerebrovasculature in the pathogenesis of both vascular cognitive impairment and dementia (VCID) and Alzheimer's disease (AD). Traditional imaging methods face difficulties with the thicker skull of older brains, making high-resolution imaging and cerebral blood flow (CBF) assessment challenging. However, functional ultrasound (fUS) imaging, an emerging non-invasive technique, provides real-time CBF insights with notable spatial-temporal resolution. This study introduces an enhanced longitudinal fUS method for aging brains. Using elderly (24-month C57BL/6) mice, we detail replacing the skull with a polymethylpentene window for consistent fUS imaging over extended periods. Ultrasound localization mapping (ULM), involving the injection of a microbubble (<<10 μm) suspension allows for recording of high-resolution microvascular vessels and flows. ULM relies on the localization and tracking of single circulating microbubbles in the blood flow. A FIJI-based analysis interprets these high-quality ULM visuals. Testing on older mouse brains, our method successfully unveils intricate vascular specifics even in-depth, showcasing its utility for longitudinal studies that require ongoing evaluations of CBF and vascular aspects in aging-focused research.

National Implementation of an Artificial Intelligence-Based Virtual Dietitian for Patients With Cancer.

Nutritional status is an established driver of cancer outcomes, but there is an insufficient workforce of registered dietitians to meet patient needs for nutritional counseling. Artificial intelligence (AI) and machine learning (ML) afford the opportunity to expand access to guideline-based nutritional support. An AI-based nutrition assistant called Ina was developed on the basis of a learning data set of >100,000 expert-curated interventions, peer-reviewed literature, and clinical guidelines, and provides a conversational text message-based patient interface to guide dietary habits and answer questions. Ina was implemented nationally in partnership with 25 advocacy organizations. Data on demographics, patient-reported outcomes, and utilization were systematically collected. Between July 2019 and August 2023, 3,310 users from all 50 states registered to use Ina. Users were 73% female; median age was 57 (range, 18-91) years; most common cancer types were genitourinary (22%), breast (21%), gynecologic (19%), GI (14%), and lung (12%). Users were medically complex, with 50% reporting Stage III to IV disease, 37% with metastases, and 50% with 2+ chronic conditions. Nutritional challenges were highly prevalent: 58% had overweight/obese BMIs, 83% reported barriers to good nutrition, and 42% had food allergies/intolerances. Levels of engagement were high: 68% texted questions to Ina; 79% completed surveys; median user retention was 8.8 months; 94% were satisfied with the platform; and 98% found the guidance helpful. In an evaluation of outcomes, 84% used the advice to guide diet; 47% used recommended recipes, 82% felt the program improved quality of life (QoL), and 88% reported improved symptom management. Implementation of an evidence-based AI virtual dietitian is feasible and is reported by patients to be beneficial on diet, QoL, and symptom management. Ongoing evaluations are assessing impact on other outcomes.

National implementation of an AI-based virtual dietitian for patients with cancer.

1500 Background: Nutritional status is an established key driver of cancer outcomes and patient experience. However, the workforce of oncology dietitians is unable to meet the needs of the population, and 80% of patients seek but do not receive nutrition support. Advances in artificial intelligence (AI) and machine learning (ML) capabilities afford the opportunity to expand reach and rapidly hone in on clinical and contextual needs to deliver evidence-based nutritional guidance. Methods: To address this unmet need, an AI-based nutrition expert-platform was developed. Interventions were curated by oncology-nutrition experts based on peer-reviewed literature and clinical guidelines to facilitate self-management of cancer side effects and optimize nutrition. A growing database of over 114,000 evidence-based interventions powers Ina, a text-message based virtual nutrition assistant. Interventions are continually enhanced and refined using AI and ML applied to an extensive learning dataset. The tool was implemented nationally in partnership with 25 cancer advocacy organizations. Data on demographics, patient-reported outcomes, and utilization were systematically collected. Results: Between July 2019 and August 2023, 3,310 users from all 50 states registered for the virtual nutrition platform. Based on self-report, users were 73% female; mean age 57 years (18-91); most common cancer types were GU (22%), Breast (21%), Gyn (19%), GI (14%), and Lung (12%), representing nearly 90% of users. Users were medically complex, with 50% reporting Stage 3-4 disease, 64% with metastases, and 50% with 2+ chronic conditions. Nutritional challenges were highly prevalent: 58% were overweight/obese by BMI, 83% reported barriers to good nutrition, and 42% had food allergies/intolerances. Levels of engagement were high: 68% of users texted queries to Ina, 79% completed surveys, and median user retention duration was 8.8 months. Overall, 94% of users reported being satisfied with the platform and 98% found the guidance to be helpful. In an evaluation of outcomes, 84% reported actively using the nutrition advice to guide their diets, 47% used the recommended recipes, and 82% felt the program improved their quality of life. In this cohort with high symptom burden, 88% reported Ina helped them manage their symptoms and 34% noted improved symptom control during participation. Conclusions: Implementation of an evidence-based AI virtual dietitian is feasible, and is reported by patients to be beneficial on diet, quality of life, and symptom control. Ongoing evaluations are assessing impact on other outcomes.

Coping strategies and interventions to alleviate moral distress among pediatric ICU nurses: A scoping review.

Moral distress significantly affects pediatric ICU nurses, leading to nurse burnout, increased turnover and reducing patient care quality. Despite its importance, there's a notable gap in knowledge on how to manage it effectively. This review aimed to systematically identify and analyze coping strategies and interventions targeting moral distress among pediatric nurses in ICU, uncovering research gap and future studies directions. A scoping review was conducted followed framework by Levac, Colquhoun, and O'Brien and Arksey and O'Malley. Searches were performed in 11 electrical databases, like PubMed and China Biology Medicine disc, within a timeframe of the database construction to November 2023, and performed literature screening and data extraction. Sixteen articles were ultimately included. Coping strategies adopted by pediatric ICUs nurses can be categorized into adaptive and maladaptive strategies, with the latter including passive acceptance, taking leave, and drinking, while the former involve pursuing interests outside of work, reflection and philosophizing, and communication. Nine articles described and evaluated the effectiveness of interventions for moral distress, categorizing them into individual and institutional levels. Individual-level interventions include Interprofessional Perspective-Taking, the PICU Resiliency Bundle, Ethics Education/Skills, and the Center for Caring. Institutional-level interventions encompasses Comprehensive Care Round, Goals of Care Conversations, Pediatric Ethics and Communication Excellence Rounds, Nursing Ethics Council, and Medical Ethical Decision-Making, though not all were effective in alleviating moral distress. Nurses often use self-adjustment strategies for moral distress, institutional ethical support focusing on enhancing nurses' moral resilience, promoting reflective thinking and improving communication remains crucial. Various interventions for moral distress are currently available, but nurse engagement is low and their effectiveness remained to be verified. Future studies should explore what aids or hinders these interventions. There's also a need for large, multicenter trials and ongoing evaluations to create effective support systems for pediatric ICU nurses.